1. Health Information Systems Analyst
Mobile technology for community health
Dominic Atweam K
Health Information Systems Analyst
Policy Planning Monitoring and Evaluation Division- Ghana Health Service

2. Overview What is MoTeCH? Pregnant Parents Application (MOBILE MIDWIFE)
Tools for Community Health Workers(HIMS)
General intro to presentation

3. What is MOTECH?
Using mobile phones to increase the quantity and quality of maternal and child health services in Ghana
Focus on frontline community health facilities (CHPS zone, Health Centre's)
There are other similar programme running on different plat forms but performing the same functions as MOTCH
GHS NMCSSP eREgister
GHS - Sene Smart Phone Project

4. Overview What is MoTeCH? Pregnant Parents Application (Mobile Midwife)
Tools for Community Health Workers (HIMS)
Social Impact Assessment

5. Challenges in Communities
ANC visits start late
Incomplete ANC coverage
Delay until newborns seen
Unattended births
Patchy immunization coverage
Low IPT uptake
Local myths
When considering communities issues around Maternal and Child Health:
pregnant women are often late to report to the CHPS compound, resulting in late uptake of ANC
not all of our mothers are attending for at least 4 antenatal visits
post natal care uptake for newborns is low
vaccination schedules are not followed reliably
IPT uptake is low
and local myths sometimes encourage practices which are damaging to people’s health

6. MOTECH Component 1: Mobile Midwife
Messages provide key MCH information for “pregnant parents” and reminders to seek timely care:
Personal care during pregnancy
Newborn care
Recognition of danger signs
Developmental milestones
Nutrition and breastfeeding
Malaria
Immunization
Postpartum family planning
Diarrheal diseases
Pneumonia
MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes.
Provides weekly, relevant, actionable pregnancy care voice messages in local languages
3 messages a week , Tailored to stage of pregnancy, and first year of child’s life, Women use their own or , household/compound phones, Free service
Provides maternal and child health information and encourages better and timely health-seeking behavior

7. Pregnant Parents’ Service
Engage Both Parents
Relevant, actionable and fun information by SMS and/or voice
Encourage health seeking behavior
Available in local languages
Product Development
Consultation with GHS stakeholders at all levels, midwives, lactating and expectant mothers, fathers, mothers- in-law, village chiefs.
Field testing of messages to ascertain appropriate messaging, voice, accent, dialect.
MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes.
The service has been developed in collaboration with GHS policy makers and Upper East management, midwives, pregnant women and other community members. The content aims to address user’s knowledge gaps and support the work of the CHPS workers. Early and constant consultation with real potential users has helped MoTeCH to ensure they are creating a useful service.

8. Why do we need injections for both mother & baby?
What do we do about body swelling during pregnancy?
Why do I need IPT?
Why should we practice exclusive breast feeding?
These are some of the questions that potential users have asked . It is these kinds of questions that we are able to answer through the service.
Why should
I attend clinic at first
signs of pregnancy?
Why do I vomit when I’m pregnant?

9. Overview What is MoTeCH? Pregnant Parents Application (mobile Midwife)
Tools for Community Health Workers(HIMS)
To address some of the challenges faced by nurses, MoTeCH has developed Simplified Registers and a mobile system to capture some patent data.

10. HIMS Challenges For Nurses
Volume of paper: up to 20 different patient registers for each facility
Onerous data reporting: nurses spend 4-6 days per month aggregating data
Little information flows back to the nurse: difficult to identify defaulters or high risk patients
Nurse attitudes sometimes discourage clients from seeking health information
For the CHPS nurses there are challenges in the reporting systems which rely on cumbersome paper forms, which take days per month to complete, detracting from the time the nurses are spending with their patients. Information which nurses record in their registers does not flow back to the nurse in a way that is useful for reporting or service provision.

11. PROBLEM: SOLUTION: Too much paper,
too little useful information
SOLUTION:
Using the mobile phone for data entry and management
MoTeCH is enabling nurses to enter some of the information on the simplified registers on to a mobile phone. Doing this enables us to automatically generate some of the nurses’ monthly reporting. It is hoped that this will reduce the amount of time that nurses spend on administrative tasks. By capturing patient data on the mobile phone MoTeCH is also able to send the nurses reminders about patients who are due or overdue for care. For instance we can send nurses’ lists of all antenatal defaulters. It is hoped that this will make it easier for nurses to follow up on patients, resulting in better coverage of care. The phones are simple, low cost handsets which will be provided by MoTeCH.
The simplified registers and mobile phone service together aims to reduce the burden of reporting and patient tracking for the nurse – reducing the many different registers that are currently in existence….

12. MOTECH Component #2: Nurses’ Application
Data collection & Reporting
Simplified paper registers
Nurses record patient data onto mForms
Upload data to central database
Data validation ensures high data integrity
Generates monthly reports for nurses and district officials
Alerts & Reminders
Sends alerts and reminders to nurses and clients about patient care
We started with Nokia 1680 and migrated to Nokia 2330 and subsequently to Nokia C1. Currently the program is using Nokia ASHA 200.

13. Phone-based health education Phone based alerts and reminders
System effect
MOBILIZE SUPPLY
Simplified Register
Capture and store data more efficiently +
Health worker focused mobile intervention
information to support service delivery and continuity of care
Improved supervision and feedback
Increase quantity and improve quality of interactions between clients and health system
Improve work routine and time for service delivery
MOBILIZE DEMAND
Phone-based health education
to pregnant women and new mothers to increase knowledge and awareness
Phone based alerts and reminders
at “critical” times to promote and encourage utilization of essential health services

14. MOTECH Pilot-to-Scale
& Transition to GHS
Aug 2010:
Pilot in KNW District, Upper East Region
Sept 2011: Replication in Awutu Senya District, Central Region
March 2012: Phase II: Scale & Transition
To date
Full implementation in 2 districts in 2 regions – Upper East, Central
Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra
Approximately 23,783 clients currently enrolled (2 districts)
` 100 facilities reporting (automated or enroute to automation)
469 nurses trained and using MOTECH
(automated or enroute to automation)

15. (Sustainable) Scale-up Status
National steering committee formed and chaired by Director General of GHS, similar platforms at Regional & District level actively leading the program
Proposed joint initiative to scale to an entire Region, led by GHS with TA from Grameen
Possible MTN partnership: fee-based Mobile Midwife service that will cross- subsidize the free service for those who cannot aford.
There are other similar programme running on different plat forms performing the HIMS COMPONENTS of MOTECH
GHS community eRegister
GHS - Sene Smart Phone Project
The Pregnant Parent Components(messaging ) to be integrated into the GHS Community eRegister

16. Challenges Ahead
Need for full implementation of national ehealth strategy to:
ensure alignment and interoperability between MOTECH and other mhealth/ICT solutions in Ghana
integration of the Nurses Application into DHIMS2 and GHS community eRegister systems
Costing/packaging MOTECH model for full integration into GHS workplans and budgets
Cost of airtime remains high, need for negotiation with Telcos to bring rates down and increase network coverage
Securing mobile phones in high volumes at low prices for nurses
GHS resource availability to support roll out – health sector budget already strained,
Need to demonstrate the cost-efficiency of MOTECH vs. non- mhealth approaches for frontline data management/reporting and getting health information to women

17. GHS HIMS STRATEGY DHIMS2 Integration Tools
Clinical Information Systems
Community eRegister/Motech messaging
Other Systems
Data Warehousing and Reporting
Data Integration
Transactional Data

18. Questions & Answers